What assessments are needed to provide support for an accurate periodontal diagnosis and treatment plan? Gathering assessments is the first step in the dental hygiene process of care. The assessments provide the foundation for the diagnosis, treatment planning, implementation, and evaluation. The information and procedures that are necessary for the assessments needed to provide support for accurate periodontal diagnosis and treatment plan are the following:
Medical History: The medical history is obtained at the initial appointment and is reviewed and updated at each dental hygiene appointment. The medical history can me obtained verbally by asking the patient questions from the medical history form and then recording responses from the patient on the form. The importance of the medical history should be explained to the patient so that the patient does not omit information that they believe does not relate to their mouth and dental problems. The patient should be made aware of the role that some systemic diseases, conditions, or behavioral factors may play in the cause of periodontal disease and the powerful influence that oral infection may have on the occurrence and severity of a variety of systemic diseases and conditions (Carranza 541). With the clinician reviewing the medical history of the patient, this helps ensure the patient's health and safety. The medical history helps and guides the clinician in finding oral manifestations of systemic diseases such as xerostomia, detection of systemic conditions that could affect the response of oral tissues, and the detection of systemic infections that may require special precautions and modifications in treatment planning and its procedures.
Dental History: The chief complaint of the patient and the reason for seeking the dental treatment should be addressed primarily. This is important to identify and discuss during treatment which aids in establishing rapport with the patient and is therefore able to assess the immediate need of the patient. Also included is previous dental treatment and radiograph history. Clinicians need to know both of these in order to ensure that they aren't exposing the patient to more radiation as well as in order to prevent cleanings in a more than necessary interval. Asking specific dental questions is a must to assist the clinician in his/her diagnosis, prognosis, and treatment plan. Also included are any oral habits; cleaning, grinding, smoking, bleeding while brushing, etc.
Extra oral and intra oral exam- An important part of a patients visit to the dental office is the examination of the head and neck. The clinician checks to see if tissues are normal or if there are any conditions requiring further investigation. It includes the soft tissues along with checking for asymmetries of lymph nodes of the head and neck along with the tissues inside the mouth. If an abnormality is seen, the clinician will note details such as type, size, color, location, surface texture, and consistency of the lesion or abnormality.
Oral hygiene assessment- During the oral hygiene assessment with our patients we try to measure the cleanliness of the oral cavity. We try to measure this by the extent of accumlated food debris, plaque, materia alba and tooth surface stains. A disclosing solution may be used to detect plaque that would be unnoticed to the patient. Odors in the mouth may also be of disgnostic significance. By assess the cleanliness or the oral hygiene it allows for us as clinicians to determine the extent or way we give oral hygiene instructions to our patient.
Periodontal assessment including:
Gingival Description- The color contour, consistency and texture and all part of the free gingival description. The color, consistency and texture are part of the attached gingiva. Different types of systemic factors and medications can all effect the gingival description.
Marginal Bleeding Index
Periodontal Probing- the primary purpose of probing is to measure pocket depths around the tooth in order to establish the states of health of the periodontium. When probing it is important to keep the periodontal probe parallel to the contours of the tooth and to insert the probe down to the base of the pocket. Healthy probing depths are 1-3mm, anything higher indicates inflammation and possible bone loss.
BOP%- is induced be a gentle manipulation of the tissue at the depth of the gingival sulcus when the clinician is assessing the depth of the pocket with a probe. Bleeding on probing often is a sign of inflammation in the tissue area. BOP may be caused by the accumulation of plaque at the gum line due to not brushing and flossing. However there may be other causes of BOP due to systemic factors. Examples are malnutrition, Diabetes Melitus, leukemia, use of anticoagulants, and hormonal imbalances during pregnancy and puberty. The absence of BOP is an excellent predictor of periodontal stability. When present in several sites of advance disease, BOP is a good indicator of progressive attachment attachment loss.
Recession-This is measuring of the gingival that has moved apically from the crown. Sometimes this apical migration is below the CEJ. It is measured in mm and the patient may present with sensitivity due to having the exposed cementum. These patients with exposed cementum are at a higher risk for root decay due to the cementum being less mineralized compared to the enamel.
Attachment Level
Furcations- The extent and configuration of the furcation detects are factors in both diagnosis and treatment planning. According to Carranza there are four classes of furcations. Class I- is the early stage of furcation involvement. The pocket is suprabony and primary affects the soft tissues. Class II- Can affect one or more of the furcations of the same tooth, the furcation lesion is essentially a cul-de-sac with a definite horizontal component. Class III- The bone is not attached to the dome of the furcation. The clinician will be able to identify a class III on the radiographs. Class IV- The inter-dental bone is destroyed, and the soft tissues have receded apically. The clinician will be able to see this clinically. (Carranza 992)
Mobility- all teeth have slight physiologic movement, when loss of support has occured there may be horizontal and/or vertical movement. Mobility is noted in the following classes: (+) normal mobility, (I) Slightly more than normal, (II) Moderately more than normal, (III) Severe mobility faciolingually and mesiodistally, combined with vertical displacement. RK7 Tooth mobility is increased with pregnancy and is sometimes associated with menstrual cycle or the use of hormonal contraceptives.
Fremitus
Angles Classifications- Class I, II or III. Bilateral or unilateral? The patient's occlusion may directly affect other findings, such as attrition and mobility. Injury of periodontal tissue can be a result from occlusal forces. Specific interventions (therapeutic occlusion) may be necessary prior to Phase I therapy (Carranza 846) TL 8.
Facial Profile
Salivary Flow- determination of adequate or inadequate salivary flow and any influencing factors to decrease in salivary flow
Calculus code: light, light/medium, medium, medium/heavy, medium/heavy II, heavy.
Radiographic Evaluation- identifies crown to root ratio, trebecular pattern, presence of lamina dura, height of the alveolar bone, changes in the PDL, as well as any radiopaque or radiolucent lesions, any periodontal or endodontic lesions, as well as any vertical or horizontal bone defects. Also will discuss current restprations and their integrity, presence of caries as well as any open contacts.
ADA and AAP Classification
Plaque index: Plaque index is taken to identity areas where patients need to concentrate more on. It is important for us as clinicians to educate our patients on the harmful effect that plaque has on teeth and how it relates to periodontal disease and caries. Gaining patients corporation in their home care is essential in preventing periodontal disease.
While the clinician is gathering assessments any abnormal tooth wear should be indicated in the patients notes. This would include:
Abrasion, Abfraction, Attrition, clinically visible caries,and Erosion
- Medical History: The medical history is obtained at the initial appointment and is reviewed and updated at each dental hygiene appointment. The medical history can me obtained verbally by asking the patient questions from the medical history form and then recording responses from the patient on the form. The importance of the medical history should be explained to the patient so that the patient does not omit information that they believe does not relate to their mouth and dental problems. The patient should be made aware of the role that some systemic diseases, conditions, or behavioral factors may play in the cause of periodontal disease and the powerful influence that oral infection may have on the occurrence and severity of a variety of systemic diseases and conditions (Carranza 541). With the clinician reviewing the medical history of the patient, this helps ensure the patient's health and safety. The medical history helps and guides the clinician in finding oral manifestations of systemic diseases such as xerostomia, detection of systemic conditions that could affect the response of oral tissues, and the detection of systemic infections that may require special precautions and modifications in treatment planning and its procedures.
- Dental History: The chief complaint of the patient and the reason for seeking the dental treatment should be addressed primarily. This is important to identify and discuss during treatment which aids in establishing rapport with the patient and is therefore able to assess the immediate need of the patient. Also included is previous dental treatment and radiograph history. Clinicians need to know both of these in order to ensure that they aren't exposing the patient to more radiation as well as in order to prevent cleanings in a more than necessary interval. Asking specific dental questions is a must to assist the clinician in his/her diagnosis, prognosis, and treatment plan. Also included are any oral habits; cleaning, grinding, smoking, bleeding while brushing, etc.
- Extra oral and intra oral exam- An important part of a patients visit to the dental office is the examination of the head and neck. The clinician checks to see if tissues are normal or if there are any conditions requiring further investigation. It includes the soft tissues along with checking for asymmetries of lymph nodes of the head and neck along with the tissues inside the mouth. If an abnormality is seen, the clinician will note details such as type, size, color, location, surface texture, and consistency of the lesion or abnormality.
- Oral hygiene assessment- During the oral hygiene assessment with our patients we try to measure the cleanliness of the oral cavity. We try to measure this by the extent of accumlated food debris, plaque, materia alba and tooth surface stains. A disclosing solution may be used to detect plaque that would be unnoticed to the patient. Odors in the mouth may also be of disgnostic significance. By assess the cleanliness or the oral hygiene it allows for us as clinicians to determine the extent or way we give oral hygiene instructions to our patient.
- Periodontal assessment including:
- Gingival Description- The color contour, consistency and texture and all part of the free gingival description. The color, consistency and texture are part of the attached gingiva. Different types of systemic factors and medications can all effect the gingival description.
- Marginal Bleeding Index
- Periodontal Probing- the primary purpose of probing is to measure pocket depths around the tooth in order to establish the states of health of the periodontium. When probing it is important to keep the periodontal probe parallel to the contours of the tooth and to insert the probe down to the base of the pocket. Healthy probing depths are 1-3mm, anything higher indicates inflammation and possible bone loss.
- BOP%- is induced be a gentle manipulation of the tissue at the depth of the gingival sulcus when the clinician is assessing the depth of the pocket with a probe. Bleeding on probing often is a sign of inflammation in the tissue area. BOP may be caused by the accumulation of plaque at the gum line due to not brushing and flossing. However there may be other causes of BOP due to systemic factors. Examples are malnutrition, Diabetes Melitus, leukemia, use of anticoagulants, and hormonal imbalances during pregnancy and puberty. The absence of BOP is an excellent predictor of periodontal stability. When present in several sites of advance disease, BOP is a good indicator of progressive attachment attachment loss.
- Recession-This is measuring of the gingival that has moved apically from the crown. Sometimes this apical migration is below the CEJ. It is measured in mm and the patient may present with sensitivity due to having the exposed cementum. These patients with exposed cementum are at a higher risk for root decay due to the cementum being less mineralized compared to the enamel.
- Attachment Level
- Furcations- The extent and configuration of the furcation detects are factors in both diagnosis and treatment planning. According to Carranza there are four classes of furcations. Class I- is the early stage of furcation involvement. The pocket is suprabony and primary affects the soft tissues. Class II- Can affect one or more of the furcations of the same tooth, the furcation lesion is essentially a cul-de-sac with a definite horizontal component. Class III- The bone is not attached to the dome of the furcation. The clinician will be able to identify a class III on the radiographs. Class IV- The inter-dental bone is destroyed, and the soft tissues have receded apically. The clinician will be able to see this clinically. (Carranza 992)
- Mobility- all teeth have slight physiologic movement, when loss of support has occured there may be horizontal and/or vertical movement. Mobility is noted in the following classes: (+) normal mobility, (I) Slightly more than normal, (II) Moderately more than normal, (III) Severe mobility faciolingually and mesiodistally, combined with vertical displacement. RK7 Tooth mobility is increased with pregnancy and is sometimes associated with menstrual cycle or the use of hormonal contraceptives.
- Fremitus
- Angles Classifications- Class I, II or III. Bilateral or unilateral? The patient's occlusion may directly affect other findings, such as attrition and mobility. Injury of periodontal tissue can be a result from occlusal forces. Specific interventions (therapeutic occlusion) may be necessary prior to Phase I therapy (Carranza 846) TL 8.
- Facial Profile
- Salivary Flow- determination of adequate or inadequate salivary flow and any influencing factors to decrease in salivary flow
- Calculus code: light, light/medium, medium, medium/heavy, medium/heavy II, heavy.
- Radiographic Evaluation- identifies crown to root ratio, trebecular pattern, presence of lamina dura, height of the alveolar bone, changes in the PDL, as well as any radiopaque or radiolucent lesions, any periodontal or endodontic lesions, as well as any vertical or horizontal bone defects. Also will discuss current restprations and their integrity, presence of caries as well as any open contacts.
- ADA and AAP Classification
- Plaque index: Plaque index is taken to identity areas where patients need to concentrate more on. It is important for us as clinicians to educate our patients on the harmful effect that plaque has on teeth and how it relates to periodontal disease and caries. Gaining patients corporation in their home care is essential in preventing periodontal disease.
While the clinician is gathering assessments any abnormal tooth wear should be indicated in the patients notes. This would include:Abrasion, Abfraction, Attrition, clinically visible caries,and Erosion